Rotherham Social Prescribing Service

Presentation to:

Northamptonshire Health & Wellbeing Board 22nd October 2015

Janet Wheatley : CEO Voluntary Action Rotherham

Social Prescribing Strengthening individuals, strengthening communities

Provides a framework for:

1. Connecting people with long term conditions,

referred through case management teams, to

sources of support in their community

2. Linking a Voluntary Sector Advisor to each

practice to support the GP and primary care

team to find community activities that meet

patient needs

3. Rotherham SPS started April 2012 first

referrals September 2012

4. Extended to a pilot project working with RDASH

mental health teams. Pilot started 1st April 2015

Why are we doing it? Strengthening individuals, strengthening communities

• Improving health and wellbeing outcomes cannot be achieved through more

efficiency in services alone….To reach and engage communities the

statutory sector needs to collaborate effectively with people, community

group, charities and social enterprises

• There is another way; through greater flexibility, looking to where

organisations are effectively funded, and working collaboratively,

Interim report co-produced by representatives of the VCSE sector and the Department of Health, NHS England, and

Public Health England. NHS Interim Review into VCS March 2015

• In order to make general practice more sustainable we need to ensure that

people get the most appropriate help at the right time, and this includes

making more use of non-clinical interventions when this is appropriate.

Improving General Practice – A Call to Action NHS England March 14

Process Measures

3627 referrals in to SPS

5865 referrals out to VCS services

(4571 to commissioned services

1294 to non commissioned services)

1487 referrals out to non-VCS

2058 signposts

35 GP practices

Highest referring GP Practice –

390 referrals

51% aged 80+

12.5% aged under 60

4% BME

0 500 1000 1500

Community Activity -…

Information and Advice -…

Befriending at home

Community Transport

Community Link Worker…

OT assessment

Complementary Therapies…

Enabling (one to one…

Carer Respite

Advocacy

Dementia Support Worker…

Community Activity - Exercise

Fire Safety Assessment

Information and advice - Other

Social Care Assessment

Counselling

Community Exercise…

24/7 Community Alarm

Information and Advice -…

Home Exercise

Community Activity -…

Carers Assessment

Assistive Technology

Library services (Home…

Rehabilitation services (NHS)

Fire Safety Assessment

Social Prescribing - referrals to services

What Impact is it having -Independent

Evaluation by CRESR, Sheffield Hallam

Quantitative analysis explored change over time

Change in the number of hospital episodes

• Comparing period 12 months before/after SPS patient referral

• Covers 939 patient who substantively engaged with SPS up March 2014

Change in well-being outcome measures

• Comparing baseline and follow-up scores for SPS patients

• Focus on 'low-scoring' patients to identify most positive change

Qualitative analysis explored impact from different perspectives

• Focus on what impact looks like in reality and practice

• Lived experience and narratives of Social Prescribing

Hospital Episodes - change over 12

months Non-elective Inpatient Admissions:

• Finished Consultant Episodes (FCEs): 7 per cent reduction

• Inpatient Spells: 11 per cent reduction

• Bed Days: no statistically significant change

A&E Attendance:

• All patients: 17 per cent reduction

This data is for all patients and doesn't tell the whole story: more

detailed analysis shows marked differences between different

types of patients, in particular:

• By age

• By level of engagement with SPS

Hospital Episodes - analysis by age

When patients over 80 are excluded from the analysis reductions

are greater (513 patients remaining)

Non-elective Inpatient Admissions:

• Finished Consultant Episodes (FCEs): 19 per cent reduction

• Inpatient Spells: 20 per cent reduction

• Bed Days: no statistically significant change

A&E Attendance:

• All patients: 23 per cent reduction

Highlights importance of ensuring SPS is appropriate for patients

who are referred

Impact of SPS on older (80+) patients needs to be understood

through other measures

Hospital Episodes - analysis by

engagement levels When patients continue to access VCS services after initial service

has ended much larger reductions are evident

Non-elective Inpatient Admissions:

• Finished Consultant Episodes (FCEs): 53 per cent reduction

• Inpatient Spells: 51 per cent reduction

• Bed Days: 43 per cent reduction

A&E Attendance:

• All patients: 35 per cent reduction

Highlights the importance of sustained engagement with VCS

services

Wellbeing Improvements

• 83% of patients made progress in at least one outcome area

65

59 58

52

56

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62

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10

20

30

40

50

60

70

80

Feelingpositive

Lifestyle Lookingafter

yourself

Managingsymptoms

Work,volunteeringand social

groups

Money Where youlive

Family andfriends

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Proportion of low scoing patients making progress

Patient Benefits/

Quality Improvements

More person centred approach

• Reduced dependence Increased independence

• Improved quality of life

• Increased patient choice and control

• Impacts on wider family and community

Empowering Patients and engaging communities

• Helps with co-design of services, better use of services to meet needs

of patients rather than services

• Nurtures increases the role of volunteers & partnerships with the VCS

• Helps promote equalities and reduce inequalities

• Increasing Rotherham resources and community asset base

Cost/Benefits

The service costs £1,171 per patient substantively engaged

Reductions in in-patient and A&E lead to savings of:

This does not take into account wider possible savings due to

reduced demand on GPs and social care

After 12 months Lasts 3 years? Lasts 5 Years?

£s

saved

ROI £s

saved

ROI £s

saved

ROI

Per patient

engaged

£269 £0.23 £523 £0.45 £769 £0.66

Per patient under

80

£534 £0.46 £1,038 £0.89 £1,527 £1.30

Per patient

continuing to

access VCS

£902 £0.77 £1,753 £1.50 £2,580 £2.20

Impact on Better Care Fund

outcomes

• ‘I've been more at peace with myself, I don't have to move now which has made

me feel better, my neighbours are like my friends and I was sad about leaving

them, I am more independent now around my own home’

• ‘I don’t know what my life would have been like without social prescribing coming

into my life when it did. I probably would have ended up in hospital like I have in

the past.’ (Following support from VCS Advisor and referral to home based advocacy and

benefits support service)

• ‘I would like to say you are doing an amazing job and it is with many thanks from

me and my son that I am writing this. I don't know what I would have done

without your help and support …… Thank you to everyone involved and for your

help in our hour of need’

• ‘What you have done for me is change my life for the better I have found the old

me again. I feel like a kid at Christmas again.’

• ‘I have slept 7 hours for the first time in 15 years’

• ‘Thank you so much, you have made me believe in myself again’

Case Studies Last year we reported three broad outcome themes that emerged:

improved well-being; reduced social isolation/loneliness; more

independence

This year, we followed up some of these case studies to see how

things had changed for patients

• Mr D - a stroke victim - is still going to the community Gym more than

two years after being referred through social prescribing. He has made

progress physically and mentally. 'I'm getting better each week, each

month, each year'

• Since his social prescribing referral Mr B has found work as a security

guard, he is volunteering whenever he can. 'Its given me more

confidence'. The voluntary work helped keep him busy whilst looking

for a job and provided experience of 'dealing with people better', which

he can use in his current job.

• Mrs C has continued to receive support from an advocate. She says

'half of my life feels right' due to this service, and without it she would

be desperately lonely.

Key Learning Points The need for key contacts, building and maintaining relationships

and champions – get the CCG, GP’s and VCS on board

Be in the right place, right time, with the right idea, pitched to the

right people

Leap of faith – the importance of time and scale

Role of lead bodies – implications for contracting and micro-

commissioning

Support the VCS groups/ organisations as well as the patients

The need for dedicated co-ordinated staff who are integral to the

team

Be prepared to be challenged and to challenge professional

boundaries

The vital role of KPI’s and quantative as well as qualitative

independent evidence to argue the case